Running an Optometry business is not that difficult if you have the right kind of resources with you to complete all the tasks. Right from patient encounters to admissions and from checking their eye problems to getting reimbursed via perfect medical billing and coding is a work cycle. If you are new to the world of Optometry billing and coding, we are sure that you may be wondering where to begin.
Unfortunately not much is covered during your studying years, learning about optometry. It has been observed that even after you graduate, you have to begin catching up to your more experienced colleagues in the field. Learning billing and coding for optometry for eye disease is best done by learning from experienced optometrists.
There are a number of coding experts to choose from; however, we believe that many of the courses offered are prepared for the broad field of medicine and a 6-hour course that covers multiple disciplines of medicine. They only spend as little as 30 minutes on optical disease while covering cardiology, oncology, and primary care medicine.
What are the special needs of optometry coding and billing?
Let’s take a look:
Just as in other fields of medical specialty, optometry also has very specific guidelines, rules, and regulations that one needs to adhere too. You have to follow them all precisely for claim submission and reimbursement to the service provided.
Optometry or Ophthalmology services are all medical treatments done to the eye, including vision care and medical procedures done to the eye and ocular area. In such a scenario, for these services to be covered, they have to be performed by the right type of doctor.
Keep in mind that Medicare will only consider reimbursement of ophthalmology or optometry services if they’re done by a provider, whose scope of expertise is within these areas. These experts, more often than not are with specialty optometry medical billers and coders.
In simple terms: eye care services must be performed by eye doctors! If they aren’t, they must be performed only with a medical diagnosis, and only when medically necessary.
Which services are covered for reimbursement in the Optometry setting?
The number one thing that beginners of the medical billing and coding of eye care should keep in mind is that Optometry billing services are all very specific. This is due their coverage guidelines are also very specific.
These rules define the types of services that can be performed and reimbursed by Medicare.
That being said, all insurance companies have a different set of rules for claims reimbursement and coverage determinations. So for this, you need to refer to Medicare guidelines.
The Medicare guidelines also define other insurance company rules in a very significant way. They are basically the federal government’s determination of reasonable and customary services, which should be paid for.
Furthermore, numerous optometry services will be covered under vision insurance. For beginners, it is very vital to know that it is not your typical medical insurance. People have to buy vision insurance separately from their medical insurance plans (same like dental insurance). Some employers don’t even give the option of vision insurance.
Due to this situation, vision insurance plans will vary widely. They range from complete coverage of all eye-related services, to one vision screening exam per year, to coverage of only medically necessary eye services performed by a physician and not an eye doctor.
Listen, Beginners – Optometry billing for starters is a completely different world
Due to the separation in coverage (which is vision insurance and medical insurance), you can see how the Optometry specialty billing is different to other medical specialties. A vital point to ponder upon is that – in eye services, you’re not billing for medical services, but you’re billing only for those particular eye services. They need to be specifically covered under-eye insurance and performed by an eye specialist.
Furthermore, ophthalmology and optometry procedures are particularly restricted to diagnosis, frequency, and by the provider. It’s very critical to understand all of the guidelines, rules, and regulations when it comes to optometry medical billing and coding for eye claims.
If you have attention to detail, which involves making sure all your checkboxes are ticked with regards to coding and billing, be rest assured you have a smooth sail in your billing and coding endeavors.